Developing a framework for critiquing health research Essay Example

that subject area is the presentation of a detailed critique of a piece of published research. Our experience in teaching students across a range of programmed in Nursing, Health Sciences/Studies, Health Promotion and Health Policy programmed has taught us how difficult many of our students find this task.

With the help of funding from the Learning Development Unit we undertook a project to develop, implement and evaluate a research critique framework that students could use as a guide. This article analyses the content of frameworks that are commonly used to critique quantitative research and remarks that are commonly used to critique qualitative research and then presents a single framework that addresses both research approaches. This new framework is currently being used to assist teaching and learning activities relating to the critical appraisal of published research.

As such, it is still in the developmental stage and as teachers we continue to reflect on the application of this framework to our teaching. Feedback from students is essential to this development and the article presents evaluations from students who have been involved in learning activities during the early developmental stage of the framework. This evaluation is continuing and we would also welcome The need for a research critique framework The need for able and competent health care practitioners is self-evident.

One way of ensuring competence is through evidence based practice and health professionals are expected to be intelligent consumers of research, and this entails the ability to read, understand and apply published research (Murdered et al, 1981). A change of culture arose 45 Developing a framework for critiquing health research following the move of colleges of nursing into

the further and higher education sector, resulting in an educational ultra where critical enquiry and evidence-based practice is accorded greater priority (Benton, 1999).

Most students are introduced to research methods and critical appraisal during their undergraduate education, or preparation for professional practice. Yet Uncaught et al (2002) report that qualified nurses reported problems in interpreting and using research. McCauley et al (1998) highlighted how Gaps who had been introduced to a model of critical reading were shown to have applied a more appropriate appraisal to studies than those who relied on critical appraisal skills acquired previously.

Whilst literature in relation to the ability to critically appraise research is abundant in relation to nursing and to a lesser degree in medicine, there is an emerging body of evidence in relation to other health care professionals. Chalet et al (1996) identified several barriers to research-mindedness in radiographers, including a lack of knowledge of research methodologies. Demoted et al (1994) noted that this group had particular difficulty in identifying concerns with construct validity. Work in the field of health and health care is multidisciplinary and involves a variety of approaches to research.

Further the range of such research is wide, from concerns with the relationship between the health needs of a population to aspects of the provision of health services (Bowling, 2002). Government policy and professional guidance insist that professional practice should be based on evidence (Zoom & Davies, 2000). Nursing practice to be evidence-based, the need for evidence-based health promotion has been highlighted by Perkins, Sentiments & Wright (1999), who also point out that the achievement of the targets of 'Our Healthier Nation' depend on the commissioning

and implementation of effective health promotion programmed.

Given the primacy placed on the use of evidence in the field of health and health care, it is important that students are enabled to critique published research in order to determine the usefulness of that research in their chosen field of work. By 'critique' we mean the ability to critically appraise published research by identifying the strengths and weaknesses of the research and forming Judgments concerning its overall quality and applicability.

Research in the fields of nursing, health studies, health promotion and health policy can be of a quantitative or qualitative nature: both research approaches provide liable information for the disciplines and often complement each other. As such, students are required to read and critically review quantitative and qualitative studies. However, many of the available frameworks for conducting a critical review are written within the quantitative paradigm (e. G. Benton & Carjack, 2000; Poplar & Thomas, 2000).

There has been a tendency to evaluate qualitative research against criteria appropriate to quantitative research (Sandalwood's, 1986). This can result in students attempting to analyses qualitative research within a quantitative framework and thus can dead to unjustified criticism, for example, quantitative frameworks for critique will direct students to raise questions concerning reliability and validity, rather than configurability, dependability, credibility and transferability.

These activities, which may lead to students appropriating the language of quantitative research when critiquing qualitative research, can only serve to perpetuate the view of qualitative research as a 'soft science' and detract from its value as a research approach in its own right that aims to acquire quantitative research (Lingerer, 1994). There has been considerable debate concerning whether

initiative and qualitative research can be assessed using the same criteria (Mays & Pope, 2000).

While there are many criteria that will be common to both research approaches such as the identification of an appropriate question, the choice of an appropriate research design, the conduct of a thorough and relevant literature review, there are also discrete areas of difference. For example, variables are not always given operational definitions in qualitative research as sometimes the aim of the research is to seek definitions of the concepts from the viewpoint of the informants. Various frameworks were reviewed and the common eaters that relate to quantitative and qualitative research were identified.

In general guidelines tend to reflect the philosophies of the respective approaches in that guidelines for quantitative research tend to be in the form of checklists, whereas guidelines for qualitative research tend to be more discursive. Frameworks for critiquing quantitative research The framework presented by Sandwich (1996) provides a useful checklist covering points that are appropriate for critiquing quantitative research relevant to nursing and health care students and provides an explanation and rationale for critique.

Poplar & Thomas 2000) also provide guidelines specific to the critical evaluation of quantitative research papers. Benton & Carjack (2000) offer criteria for critical evaluation of research but do not state that their criteria are intended for use with a particular research approach, however, the criteria are written within the quantitative framework in so far as they refer to hypothesis, operational definitions, validity and reliability of any instruments or questionnaires. Trance & Trace's (1986) classic text offers a comprehensive list of questions to aid critical evaluation, but again it is written within

the quantitative radium.

The website of (http://www. Cyberpunks. Org. UK/research/Reading_and _Critiquing_Research. HTML) offers a framework for the Journal of Health, Social and Environmental Issues (2005) Volvo 6, No 1 areas that should be considered when critiquing a research report. There is no indication regarding which research approach this framework can be used for, but in terms of data analysis only statistical analysis is mentioned, yet hypotheses are not mentioned. In addition, there are many important omissions, for research design, recommendations, example, limitations.

While considering a range of frameworks focusing on initiative research the areas that appeared most consistently were in relation to the research design; hypothesis, operational definitions, population and sampling, sampling methods, validity and reliability of data collection, data analysis and generalization. However, there were a plethora of critique frameworks that focused on very specific designs, rather than on generic quantitative research, and these of necessity had far more detailed guidelines for critique.

The website of the University Wales (www. UCM. AC. UK/library/critical_appraisal/forms) offers different frameworks for appraising systematic views; randomized control trials; trials without randomization; cohort (longitudinal) studies; controller studies and cross-sectional studies. This in itself pre-supposes a level of research design awareness that is likely not to be evident in undergraduate students during the early stages of their programmed of study.

While there appears to be some degree of consensus concerning the areas that should be addressed when critiquing quantitative research the situation is less clear when it comes to Hammerless (1992), writing specifically concerning ethnography, provides criteria for assessing ethnographic studies. Questions are raised concerning the extent to which new theory is produced, how far is the theory developed and how

novel are the claims made. He also refers to the credibility and transferability of the findings, as well as the influence of the researcher on the findings.

Mays & Pope (2000) refer to the increase in interest in assessing the quality of qualitative research and, drawing on the earlier work of Hammerless (1992), identify two broad criteria: validity and relevance. These authors acknowledge that these concepts can also be used when assessing the quality of quantitative research, UT when used in relation to qualitative research they need to be operationally differently to reflect the distinctive goals of qualitative research. The website of the Public Health Resource Unit (http://www. Hrs. Nash. UK/-?caps/quality. HTML) presents a framework for critically appraising qualitative research built around ten questions, with supporting detailed guidelines. Areas that are specific to qualitative research include the relationship between the researcher and the participants and rigor in relation to data analysis. Greenshank & Taylor (1997) provide an overview of the tauter of qualitative research and again suggest a framework for critique based on nine questions with supporting guidance.

In terms of being specific to qualitative research, the authors refer to the need to acknowledge the researcher's perspective, a detailed description of methods used for data collection, quality control measures in data analysis and the credibility of the results and the transferability of the findings to other settings. Forkful & Roberts (1993) claim that there is a paucity of guidelines for examining qualitative work and provide a framework for this purpose, which is aimed at undergraduate nurses and other health professionals.

The authors cover Lingerer's (1990) criteria for rigor, but with minimal explanation. Overall the guidelines

are relevant and useful for qualitative studies, but the Journal may not be readily accessible to all health studies students. Highly specialized texts exist that offer advice, discussion and debate, concerning the research (Lingerer, 1994; Morse & Field, 1996; Ouzel & Engel, 2001), and, inter alai, refer to issues like the context of the research and the need for an audit trail. Frameworks for critiquing both quantitative and qualitative

Zoom, Anathema & Pullman (2000) provide questions to be asked concerning quantitative research, in terms of three sections: Questions to ask about data collection instruments; questions to ask about experiments; questions to ask about surveys, case finding (or 'clinical epidemiological') studies and case control studies. They also provide questions to ask about qualitative research in which attention is drawn to the setting of the research, the researcher's role in the research and the relationship of the study to other research in the field.

Stevens, Shade, Chalk & Sliven (1993) provide a chapter n evaluating research in a book aimed at health care professionals. This is perhaps one of the most misleading guides in terms of evaluating qualitative research. A framework for research evaluation is provided and at the beginning it is acknowledged that qualitative research is not necessarily performed and presented in the same format as quantitative research. It is further stated that, in the light of this, reference will also be made to qualitative research.

Though reference is made to qualitative studies, it is inadequate and sometimes misleading, for example, in the methods section preference is made to validity and reliability in measuring instruments, but qualitative methods are ignored. Further, in the results section qualitative

findings are not mentioned. 47 Incarnadines (1998) guidelines for critique appear to follow the quantitative paradigm, however, she does stress that not all studies require a hypothesis and that "studies of a purely descriptive nature" (IPPP) may not contain hypotheses, in which case research questions may be used.

Also, under the section headed 'Research Design', Inseminates states that quantitative designs criteria. However, limited advice is offered to guide alliterative critique. Valence (2003) provides a framework that mentions quantitative and qualitative research in some sections, for example, method, but refers solely to quantitative in others, for example, analysis. Overall, the framework is heavily biased towards quantitative research, and when both approaches are discussed it is not clear which approach is being addressed.

The website of the University of Wales College of Medicine provides a series of guides on critical appraisal of research studies, all taking the format of a table that identifies a question and directs the reader to answer by kicking yes', 'no' or 'can't tell', but with no guidance as to what should be considered when answering the question. The questions are focused towards critically appraising the research for the purpose of ascertaining its relevance to practice, and assumes a high level of knowledge of research methods in order to be able to answer the questions, so would be difficult for undergraduates to use effectively.

Pharaoh (1997) takes account of both quantitative and qualitative approaches to research and provides a list of broad headings that encompass both approaches. The guidelines are comprehensive in terms of quantitative search, but less so for qualitative research. Each point for critique initially addresses quantitative strategies and is followed

by a paragraph suggesting a different approach for qualitative work. For example, Pharaoh states "in qualitative studies, researchers may not want to be influenced by previous research.

They should, however, give a rationale and make reference to the relevant literature" (IPPP). However, qualitative research is addressed with less rigor than quantitative research and the less discerning student may well confuse the two approaches. The guidelines fail to clearly et out the different criteria for each strategy, for example reliability and validity are discussed, but transferability are not referred to. However, attention is In a book written for nurses, Libido-Wood & Huber (1994) provide two separate chapters for quantitative and qualitative critique.

Dealing with the two strategies in different chapters could be difficult for the novice student who is still trying to internalize the difference between the two approaches. However, both are dealt with thoroughly and do provide useful guidelines for the more advanced students. They make useful circumferences to other chapters in the kook. Hike (1996) highlights the importance of critical evaluation as a means by which nurses can practice knowledgeably, and stresses the importance of developing critical evaluation skills, recommending a six-stage process.

Quantitative and qualitative research are both addressed within a specific guide to the sections of the research that should be considered, but the complex integration of quantitative and qualitative critique might be confusing to the novice student. Some essential components, such as setting, population and sample are omitted. Further, the guide is presented in textual format and so some detail can be lost. Burns & Grove (2001) offer frameworks for both quantitative and qualitative research in nursing, acknowledging the need for

differing approaches to the critique of different types of studies.

While their framework for quantitative research includes the standard topics like research objectives, questions or hypotheses, the definition of variables, the identification of independent and dependent variables, validity of instruments, statistical procedures, when it comes to qualitative research, other questions are raised. Burns and Grove thus refer to 'descriptive vividness', looking for clarity and factual accuracy f the researcher's account of the study. The context must be clear as data are context-specific.

Rigor in qualitative research demands a clear account of the study elements, e. G. The philosophy, the role of the researcher, the process. Audibility and a decision trail are also required and any theory derived from the study must reflect the data. Deploy & Sitting (1998) provide 'guiding questions' to critically evaluate quantitative and qualitative research studies. They present two adjacent lists, headed 'experimental-type' and 'naturalist inquiry, each with very similar questions except for the entry for